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    Adobe Scan 16 Jun 2023

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    Bi Wy Breathing problems and . sh ean cans anemia and jaundice (yell 8 7 5 DIAGNOSIS & Physteal Examination & try ® Blood Test To check for malaria parasites 8.7.6 TREATMENT Antimalanal drugs include Artemisinin drugs (artemether and artesunate) history Atovaquone Chloroquine Doxyeyeline Mefloquine Quinine ®00000 |OPPORTUNISTIC INFECTIONS infections that occur more frequently and are s, including people with HIV.” a person with HIV has { serious stage of HIV Definition: “Opportunistic infections (Ols) are more severe in people with weakened inmune system Many Ols are considered AIDS-defining conditions. That means if one ‘of these conditions, they are diagnosed with AIDS, the most infection 8.8.1 COMMON OPPORTUNISTIC INFECTIONS Some of the most common Ols in people living with HIV are 1. Herpes Simplex Virus-1(HSV-1) Infection: A viral infection that can ¢ ause sores on the lips and mouth. Salmonella Infection: A bacterial infection that atfects the intestines A fungal infection of the mouth, bronchi, trachea, lungs 3. Candidiasis Infection: esophagus, or vagina Toxoplasmosis: A parasitic infection that can affect the b 4. 8.8.2 ETIOLOGY OF OIS Ols are caused by a variety of germs (viruses, bacteria, fungi, and parasites). These germs air, in body tuids, or m contaminated tood or water. spread in different ways, such as in the They can cause health problems when a person's immune system ts weakened by HIV disease: "Gat inh INFECTIGUS DISEASES, i trenton a Ups the comp! ¥ “ements, theta al wv desenbe the cok alae. ony & fen bodes Dathogenenis st tubercuteas toe tre the pahophysihgy ae ae Th undecatst aco ettogy and pahogenens ec ltpathogenesis ant mochanran ol SALE te Cok 3 ‘To explain the lite cycle of organism at nv the lite anism of wsalaria Tuberculosis (TD is» contagious intone on eos seonsaeainey lagious infection that usually attacks the lung of individuals It cat ° © other parts of the body, like brain and spine. TB is the world’s second most common cause of death from infectious disease after HIV/AIDS. Definition: “Tuberculosis (T.B) is a highly inigctiows disease caused by several species ot mycobacterium.” It spreads very rapidly from one person to the other directly oF indirect.y “OR According to WHO: Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis! that most often affect the lungs: Tuberculosis is curable and preventable 8.1.1 CAUSATIVE AGENT Tuberculosis is caused by different species of mycobacterium viz. ‘Mycobacterium OoCUL tuberculosis (it is rod-shaped, non-spore forming, aerobic bacterium) nd mycobacterium. bovis, mycobacterium africanosum. Tuberculosis has been described as “King af diseases.” It was discovered by Robert Koch in 1882. 8.4.2 STAGES OF TUBERCULOSIS The following are the stages of TB: This happens when a person has been in contact with, or exposed o, another 1. Exposure: 2 person who has TB. The exposed person will havea yegative skin test 9 normal chest Xtay, ease. and no signs or symptoms of the dise 2, Latent TB (Inactive TB): This happens when a person has TH bacteria in his or her ody form, but does not have symptoms of the disease. The infected person's imuune ¢ off the TB organisms, and the TB remains inactive throughout fife in most tive skin test, but anormal chest \ in inactive system wall ‘ i people iho are infected. This person would have a pos TB can turn into active TB, so treatment is important. Lgns ity ray. Itis not contagious. Latent This describes the person who has s 3. Active TB: It is also called TB disease. infection. The person would have a positive skin Aege and a pasitiv symptoms of an active 139 “chest X-ra fe fed oe acterium tuberculosis) rele 7. preads by droplet sol TUBERCULOSIS 121.3 TRANSMISSION O ont 4 ris wm ‘he tisaugs The dt dina ohu se “ other. ThE tuberey 1 from one per on to am . p rit during, pve, i ihe et ents, delive! ir when the infected patient ‘ , by simply talkiy, People nearby may breathe in ted. These tuberculosis germs can settle 19 the fup, can move to other parts of the body through, ie roping. spating a and become 1) m there, these ge and begin to grow Mood S very com Tuberculosis can infect any part of the body. The tuberculosis of the lungs 1s very amon Other than lungs, it can affect kidneys, meninges, bones, lymph nodes or other B es \ Figure 8.1: Transmission of Tuberculosis (TB) 8.1.4 TYPES OF TUBERCULOSIS (TB) There are mainly two types of tuberculosi 1. Primary TB 2. Secondary TB It occurs on first exposure lo tubercle bacilli especial hi ally when LPrimary Tuberculosi droplets can avoid normal mucociliary defense n avoi nal mu es and_enter in th fale Jungs. The infection begins with the multiplication of baciti re thee Rot alveoli of upper lobe particularly towards the apex. This tore cio repens Usually inthe immunocompromised patients. Primary TB is also knows ye child sa Tee and in § childhood TB and Ghon’ shon’s complex. 2.Secondary Tuberculosis: It is ry Nis usually due to reactivation of dormant | aNt lesions ora re- infection of person who is already hypersensitive due to varli BNET eXDOSuLe, Based upon Anatomical Involvement, Tubcrculasis is classified as follow 1 Pulmonary Tuberculosis: It is aiost common type. indicates wevolvemer’ of v4 especially pulmonary parenchyma Mycobactorium tuberculosis Figure 8.2: Primary Tuberculosis 2, Extrapulmonary Tuberculosis: It indicates involvement of other organs than lungs which usually are lymph nodes, pleura, bones, genitourinary tract etc. 8.4.5 PATHOPHYSIOLOGY OF TUBERCULOSIS Infection occurs when a person inhales droplet nuclei containing tubercle bacilli that reach the alveoli of the lungs. The infective droplet nucleus is very small measuring 5 micrometers or less and may contain approximately 1-10 bacilli. 5-200 inhaled bacilli are usually ction. These tubercle bacilli are ingested by alveolar macrophages; the cilli are destroyed or inhibited: A small number may multiply released when the macrophages die. If alive, these bacilli may spread by way of lymphatic channels or through the bloodstream to more distant tissues and organs (including areas of the body in which TB disease is most likely to develop: regional lymph nodes, apex of the lung, kidneys, brain, and bone). This process of disseminahon primes the immune system for a systemic response. Within 2 to 8 weeks, special immune tells called macrophages ingest and surround the tubercle bacilli. The cells form a barrier shell, called a granuloma, that keeps the bacilli contained and under control (LTBI) If the immune system cannot keep the tubercle bacilli under control, the bacilli begin to multiply idly (TB disease). This process can occur in different areas in the body, such as the lungs. rapi - kidneys, brain, oF bone. necessary for infe majority of these ba intracellularly and are Intection of b Development of Tuberculosis ae Reactivation or reinfection 1U Currant Trend syproms oF TUBERCULOSIS ani areepenee st TH = More than 2-3 week: © Feeling unwell weeks © Chest pain when inhaling deeply © Shortness of breath © Fever © Poor appetite © Weight loss @ Excessive sweating at night © Fatigue © Unresolved pneumonia Note: The increase production of sputum and night sweat is an indication of progress of disease. d to diagnose 8.2.7 DIAGNOSIS © Mantoux test (PPD (Purified Protein derived) Skin test): It is performe: PD tuberculin is injected the presence of disease. A small amount of a substance called P! just below the skin of your inside forearm. Within 48 to 72 hours, a red swelling occurs in infected persons. The size of the swelling determines whether the test results are significant. © Chest X-rays © Blood Test: Blood tests may be used to confirm latent or active tuberculosis. The: use sophisticated technology to measure immune systems reaction to TB bacteria © Direct microscopy of samples ® CT scanning Sputum Test: If chest X-ray shows signs of tuberculosis, doctor may take samples for the testing of TB bacteria, Sputum sa st for drug-resistant strains of TB. This helps to choose the nm ‘ se tests mples can also be used to tes dications that are most likely to work, 8.1.8 TREATMENT 1.Nonpharmacological Treatment: It includes- * Adequate nutrition * Medico social awareness 7 BCG Vaccinations (Bacilli Calmetie Guerin) ~ Less crowded living conditions 7 Avoid dust 7 Avoid smoking < Disease 2 Pharmacological Treatment Line Therapy: These drugs have high antitubercular activity as well as low tow * Isoniazid (H) ~ amine ———[—=— + Rifampicin () — + Pyrazinamide (2) + Ethambutol (E) — + Streptomycin (S)~ 2. Second Line Therapy: These drugs have low antitubercular activity or high toxicity and are used in special circumstances only. * Thioacetazone — = PAS - * Ethionamide + Kanamycin- * Amikacin - - Others: These are the newer drugs which are used in the treatment of T.B. = Ciprofloxacin ~ = Ofloxacin- * Clarithromycin- * Azithromycin - Combination Therapy: These are: R (150 mg) + H (75 mg) + Z (400 mg) + E (275 mg) R (150 mg) + H (75 mg) + Z (400 mg) 5. Surgery: Surgery in skeletal tuberculosis may 8.2 PNEUMONIA ¥ 2 be suggested for faster recovery. The air sacs may P js an infection that N fiir te aon aerate a terial), causing cough with phlegm or pus, fever, culls and didi tent cera "a variety of organisms, including bacteria, viruses ‘and fungi, can eause pmeumoplls i hhyma (ie, alveoli rather than the sa tai i mation of lung parenchyma (1.c., ee EAE 7 ee reeyves the air sacs in the lungs to fill with fuid oF pus. ronchi). It happens Ww) That can make it hard to breathe in enough oxygen to reach the bloodstrean\.’ 8.3 URINARY TRACT INFECTION (UTI) v that attects any Defi nition: “A urmary tract infectien (LTT as a ma retal inteetia the urinary Iract UTI develops when bactena present atound the anus and pass up the cet na itty g We Cystine OF Rows (pyelonephritis 8.3.1 ROUTE OF INFECTION The organism can enter into the urinary tract by various routes © Via urethral up © Hematoyenour route (ia blood) © Lymphatic route © By direct contact of intection = “_ -. Sadie Urinary Tract tnfertion Lower Urinary Draet Infection Upper Urinary Pract Infeet " URE THREES . . $nfluratnida'ct cxstns URPTERITIS PYPLOSEPHRITIS ‘tn tsromatton ot Inflammation ot Inflammation st Madders vareters kuine: 1. Urethritis: It ts an mtection of urethia caused by bacteria, fungi or viruses. The infection 1s more common in women. Mostly the bacteria came (rom. and reach to the urethra 2. Cystitis: 10 is an inflammation of the bladder lining causing pamntul and frequen! urination due to microbial infection. 3. Ureteritis: It is an inflammation ‘of one or both ut commonly due to infection, spread from cither kidney or urinary bladder . 11 is an acute or chronic infextion and inflammation of the kidneys oF lower intesting (via anus! eters, The inflammation is most 4. Pyelonephritis renal pelvis caused by the bacterial infection | PYELONEPHRITIS (nflammation of Kidney? | Acute | Chronic ; “Tuberculous pyelonephritis ! yetonepbe Pyelonephritis sap essed by waite Chonie pycloneptittis ‘The renal lesion of TH in invasion that moves aoe seroma isd hotneet fron uretlo to the fof acute anilammation iy called as tuberculous Jadney sia erent? swith searnine vateiciis User hadier & wsetee spread thom bingy 83. Common organisms that causes UT fu current Tr 3 CAUSES (ETIOLOGY) Tinclude @ Eschenchia coh (Ecol) ® Staphylococcus saprophyticus ® Proteus mirabilis ® Klebsiella pnemoniae © Enterobacter ® Pseudomonas © Enterococcus 8.3.4 PATHOPHYSIOLOGY Causes: Bacteria, virus, fecal incontinence, catheterization, postponement of vording pregnancy, diabetes mellitus Bacteria ascends the urethra Lining of urinary tract becomes inflamed Micturition reflex is triggered Urgency, frequency, burning, hematuria & pyuria Hie lanmaty rca conta, ba eben 1d Gorge or, ei tata! ra Ty a etal rapt, cng ace bey my ON ous Diseases 83.5 CLINICAL MANIFESTATIONS symptoms may inehide High tev Pamtul & burning on urination Presence of blood in urine (Hematuria) Urgency to urinate especially at night Abnormal urine color (cloudy) Foul smelling urine Fatigue Nausea & vomiting Abdominal pain Oo 9GOO88 8.3.6 COMPLICATIONS OF UTI Following are the complications of UTI: © Recurrent infections, especially in women who experience three or more UTI © Permanent kidney damage due to pyelonephritis/untreated UTI. © Increased risk in pregnant women of delivery low birth weight or premature infants. © Urethral narrowing in men from recurrent urethritis. © Sepsis: A potentially life-threatening, complication, especially if infection spreads to kidney, 8.3.7 DIAGNOSIS: Routine physical examination of urine. Microscopic examination of urine sample for identification of organism. Urine culture test to check sensitivity of organism. Radiological examination (like X-ray) of kidney. Kidney function test (KFT): especially estimation of creatinine blood, urea & electrolytes ©9000 8.3.8 TREATMENT 1. Non-Pharmacological Treatment: © Increase in fluid intake to flush bacteria. © Proper cleaning after urination & sexual activity. © Avoidance of catheterization © Take cranberry juice once a day . i day : - 4 Hs See pal Feat “Antibiotic therapy to treat mild to severe condition for 2-6 . Pharmacolo} ‘ Sete aii sash, Examples: To treat mild infection: Amoxycillin & Ampicillin are used. prim, Aminoglycosides & Cephalosporins are used. To treat severe infection: Trimetho $8 ACQUIRED IMMUNE DEFICIENCY SYNDROME (AlD5) Ss ntion Jmane Dehoenes Syndrome (AIDS) I AUNT SGise This a collection at sv enptams and tnitections Fescit |e he my vstem caused by the human immunodeticaenss iris TT OK 1 adsonder Wad! 4 chisorder ot cell mediated immune system af the body, There 1 4 reduction in the number ¢ helper T cells which stimulate antibody production by B-cells 8.9.1 CAUSATIVE AGENT Ieis caused by Human Immunodeticiency Virus (HIV). It is a type of retrovirus 8.9.2 HIV VIRUS The human immunodeficiency virus (HIV) is a lentivirus (a subgroup of retrovirus) isa single strand RNA virus that replicates via reverse transcription. This virus compromises the body's ability to handle disease and causes AIDS. In this disease HIV virus affect on immune svstem and this system becomes unable fo defend itself agains! foreign invaders like bacterta, other viruses and allows the development of certain diseases. Infection with HIV occurs by the transfer of blood, semen, vaginal fluids, or breast milk. HIV infects vital cells in the human immune system such as helper T cells (specifically CDs + T cells) macrophages, and dendritic cells. 8.9.3 STRUCTURE OF HIV The virus 1s spherical with « diameter of about 90-120 nm. Its genome consists of a single- stranded RNA filament segmented into two identical filaments and associated with a zyme. The envelope consists of 2 lipid bilayer derived from host cell reverse transcriptase en. nels ‘ membrane and projecting knob like glycoprotein spikes. It contains two protein coats. _; GLYCOPROTEIN SPIKES TWO SINGLE STRANDED 72K RNA FILAMENTS SG LIPID MEMBRANE PROTEIN COATS y Cras a REVERSE ) TRANSCRIPTASE 7 ENZYM! mm D — cTRANSCRIBES Sas SNAFROM RNA) SHE 10: AIDS Virus (HIV) Figure 8. itentious Diseases. 3.9.4 INCUBATION PERIOD [he duration bets cen , pumary inlectiony 8.9.5 MODE OF TRANSMISSION HIV is transmitted by the following ways.” 1 By sexual contacts 2. Contact with infected load or body fluids 3 Shared needles : 4. Vertical transmission- mother to infant via breast milk 8.9.6 PATHOPHYSIOLOGY ‘Acquired immune deficiency syndrome (AIDS) = caused by the HIV or immunodeficiency virus. The infection causes progressive destruction immune (CMI) system, primarily by eliminating CDs + T-helper lymphoss'e After the entrance of the virus into the body of the person. the virus © macrophages where RNA genome of the virus replicates to form viral DNA sith * reverse transcriptase enzyme. This viral DNA gets incorporated mt cells DNA and directs the infected cells to produce viruses, The macrophage> produce virus and ike a HIV factory. Simultaneously HIV virus onters into helper T Iwmphe replicates and produces other viruses. This is repeated so that the number of T lymphocytes decreases in th: body of ts person. During tis period, the infected person guffers from fever, diarrhoea and seh Pees, since the number of helper "T lymphocytes decreases in the ody, the pers suffering from infections of kacterin especially Mycobacterium, viruses. MK? and oven parasites like “Toxoplasma. The patient Beis immune deficiency and he/she snable '« protect himself/herself against these infections Invading HIV virus into the host body | Uncoating & proviral DNA interaction ‘Acvon CDs + Tecellsof immune system pose ee | Weakening of Immune system NAG NOSIS Ser CN S04) ety ul # Antibody Tests: Thos te en antibody StS LOOK for + Nucleic Acid Tests (NATS) These teste 39° TREATMENT ‘ere are many Medic. Cenahons are called and prevent ARTis usually Classes. The classes of erse Transcriptase Inhibi Vto make copies of itself. Examples: Efavirenz. Rilpivirin Complications. These A combination of two or anti-HIV drugs include tors (NI fs Straten Re INRTIS): These. drugs turn off a ¢ and Doravirine. Nucleoside or Nucleotide Reverse Transcriptase Inhibitors (NRTIs): These drugs are faulty versions of the building blocks that HIV needs to make copies of itself, Examples: Abacavir, Tenofovir disop: roxil fumarate, Emtricitabine, Lamivudine and zidovudine 3. Combination drugs also are available, such as emtricitabine/tenofovir disoproxil fumarate and emtricitabine/ tenofovir alafenamide fumarate 4. Protease Inhibitors (PIs): These drugs inactivate HIV protease, anothe: protein that HIV needs to make copies of itself. Examples: Atazanavir, Darunavir and Lopinavir /ritonavir. Integrase Inhibitors: These drugs work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples: Bictegravir sodium, Raltegravit, Dolutegravir and Cabotegravir. & Entry of Fusion Inhibitors: These drugs block HIV's entry into CDs + T cells Examples: Enfuvirtide and Maraviroc. 8.10 SEVERE ACUTE RESPIRATORY SYNDROME (SARS) Definition: “Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). 8.10.4 ETIOLOGY / . a Sars 1s caused by a strain of coronavirus, the same family of viruses that causes the coos cold. Previously, these viruses had never been particularly dangerous to humans , 85 GONORRHOEA "ORT aly called as “Clap Definition, “Wis an acute intertious

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